Download the ESMO 2012 Abstract Book - Oxford Journals

maintenance therapy had favourable ICER in patients with PS = 0 (52 213 €/QALY),
in responders to induction chemotherapy (64 296 €/QALY) and in patients with
adenocarcinoma (62 292 €/QALY); erlotinib had favourable ICER if PS = 0 (94 908
€/QALY), in patients with adenocarcinoma (97 160 €/QALY) and objective response
to induction (101,186 €/QALY), but it is not cost-effective in patients with PS = 1,
other histology or if stable disease.
Conclusion: Gemcitabine and erlotinib maintenance therapy have acceptable ICER
but with wide variation, function of histology, PS and response to the first line
chemotherapy.
Disclosure: I. Borget: Honoraria from Roche for set up a class in health economy
(no relation with the present study). M. Perol: consultant or advisory board with
Roche, Lilly (myself) Honoraria from Lilly, Roche, Pfizer, Boehringer Ingelheim
(myself) Research funding from Lilly, Roche (myself). D. Perol: Honoraria : Roche
(myself). G. Zalcman: Honoraria from Lilly, Roche Research funding from Lilly,
Roche. A. Vergnenegre: honoraria and research funding from Roche. C. Chouaid:
Honoraria from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Hoffman la
Roche, Astra Zeneka, Sanofi Aventis, Lilly, Novartis and Amgen Research funding
from AstraZeneca, Lilly, Novartis and Amgen. All other authors have declared no
conflicts of interest.
1220 DOUBLET VERSUS SINGLE CYTOTOXIC AGENT AS
FIRST-LINE TREATMENT FOR ELDERLY PATIENTS WITH
ADVANCED NON-SMALL-CELL LUNG CANCER: A
SYSTEMATIC REVIEW AND META-ANALYSIS
W. Qi 1 , Y. Yao 2 , Z. Shen 2 ,A.He 2 ,F.Lin 2
1 Oncology, The Sixth People Hospital, Shanghai Jiao Tong University, Shanghai,
CHINA, 2 Dept. of Oncology, The Sixth People’s Hospital Shanghai Jiaotong
University, Shanghai, CHINA
The standard treatment for elderly patients with advanced non-small cell lung cancer
(NSCLC) is still debated. As a result, we performed a meta-analysis of all
randomized controlled trials comparing the efficacy of doublet versus single
third-generation cytotoxic agent in the elderly patients with advanced NSCLC.
Finally, eight eligible trials involved 2108 patients were identified. The intention to
treatment (ITT) analysis demonstrated that doublet therapy significantly improved
OS (HR0.85 95%CI 0.72-1.00, p = 0.048), PFS (HR 0.72, 95%CI 0.55-0.93, p = 0.012),
1-year SR (RR 1.18, 95%CI 1.02-1.36, p = 0.027) and ORR (RR1.65,95%CI 1.36-1.99,
p = 0.000), compared with single cytotoxic agent. Sub-group analysis also favored
platinum-based doublet therapy in terms of OS, PFS/TTP, 1-year SR and ORR.
Though gemcitabine-based doublet significantly increased ORR compared with
single agent (RR1.51, 95%CI 1.21-1.87, p = 0.000), it did not translate into increase in
survival benefits in terms of OS, PFS and 1-year SR. More incidences of grade 3 or 4
hematologic toxicities were observed in doublet therapy group. With respect to grade
3 or 4 non-hematologic toxicities, equivalent frequencies were found between groups
excluding more incidence of neutrotoxicity in doublet therapy group. Our data
indicated that doublet therapy was superior to single third-generation cytotoxic agent
for elder patients with advanced NSCLC. The optimal drug dosage and treatment
schedule of platinum-based doublet should be investigated in future prospective
clinical trials. Gemcitabine-based doublet could be considered for elderly patients
who were not suitable for platinum-based chemotherapy.
Disclosure: All authors have declared no conflicts of interest.
1221 WEEKLY PACLITAXEL VERSUS THE STANDARD 3-WEEKLY
SCHEDULE IN PATIENTS WITH NON-SMALL CELL LUNG
CANCER
I. Abdel Halim 1 , M. El-Ashry 2 , W. El-Sadda 1 , S. Temraz 1
1 Clinical Oncology & Nuclear Medicine, Mansoura University Hospital School of
Medicine, Mansoura, EGYPT, 2 Clinical Oncology, Mansoura University
HospitalSchool of Medicine, Mansoura, EGYPT
Background: Paclitaxel is one of the active drugs in non-small cell lung cancer
(NSCLC). Weekly paclitaxel seems less toxic and more effective compared to
paclitaxel every three weeks (possibly because of the proapoptotic and angiogenic
activity) the dose intensity is quiet higher with tolerable toxicities. The purpose of
the study is to compare the efficacy of weekly paclitaxel to the every three weeks
schedule in terms of response, toxicity profile, PFS and OS. Patients
Methods: Between Sep 2007 & Sep 2009, eighty patients were enrolled in the study,
40 in each group. Eligibility criteria were chemo-naiive patients, stage III & IV
histologically proven NSCLC, WHO PS 0-1, adequate bone marrow, kidney & liver
functions. Patients were randomized for 6-8 cycles of either weekly paclitaxel 80 mg/
m 2 D1,8,15 (1 hour IV infusion) and paraplatin AUC = 5 D1 (30 min IV infusion )
every 4 weeks (Group A) or paclitaxel 175 mg/m 2 and paraplatin AUC = 5 every 3
weeks (Group B). Prophylactic growth factor support was allowed if indicated in
Group B. Response was assessed every 2 cycles, patients who showed objective
response (CR, PR, or SD) had continued to 8 cycles.
Results: All patients were evaluable for response, toxicity, and survival. The median
age was 56 years (range 42-64) in both groups. Median WHO PS 1. Male to female
Annals of Oncology
ratio was 4:1. Stage III 60% & 62.5%, stage IV 40% & 37.5% in groups A & B
respectively. The overall response rates ware 60% (CR 10%, PR 50%) & 40% (CR 5%,
PR 35%) in groups A & B respectively. No grade IV toxicities were observed in either
group. In group A & B; grade II anemia occurred in 15 & 25% of patients, grade III
neutropenia was noted in 10 & 30% of patients, and grade II neuropathy occurred in
10 & 50% of patients in group A & B respectively. Median time to progression and
median survival were 10 & 7 months and 14 & 11 months respectively.
Conclusion: Weekly paclitaxel is more effective than the every 3 weeks
administration in the treatment of advanced NSCLC with higher RR, TTP, OS and
better toxicity profile.
Disclosure: All authors have declared no conflicts of interest.
1222 ERLOTINIB IN SECOND AND THIRD LINE THERAPY IN
ADVANCED NSCLC (STAGE IIIB AND IV), RELATION WITH
CHEMOTHERAPY AND SCHEDULE OF ADMINISTRATION
(A RETROSPECTIVE STUDY)
A. Grigorescu, I. Turtoi, S.E. Boeru
Medical Oncology, Institute of Oncology Bucharest, Bucharest, ROMANIA
Background: Is now very well known that Erlotinib (E) has an impact in progression
free survival and in some study in overall survival in second or third line therapy for
advanced non small -cell lung cancer (NSCLC). Aims of the study: This study try to
provide data which sustain the use of E in second and third line and the fact that
mono-chemotherapy could be active and after treatment with E for some patients
(Pt) with advanced NSCLC. In addition we try to find data supporting the use of E
for senior adults.
Materials and method: The data from 90 case report forms of Ps with Stage IIIB
and IV NSCLC treated with E in Institute of Oncology Bucharest between March
2010 and March 2012 were analyzed regarding clinical benefit, survival and relation
with mono- chemotherapy in second or third line. In particular we purposed to
point out the benefit of senior adults treated with E and the possible benefit of
chemotherapy with a single agent after failure of treatment with E. Main symptoms
were evaluated by Edmonton scale. Statistical analysis was perform by Caplan Meyer
curve and X2 test.
Results: 86 Pt were valuable, 17 with stage IIIB and 69 stage IV. The overall survival
for the Pt included in this study was 17 month. The survival in second line therapy
with E was 7 month (CI: 3.6 – 10.3) and the survival after third line chemotherapy
was 3 month (CI:2.1-3.8). On the whole the clinical benefit was 90% of Pt. The
response rate for chemotherapy in third line after E was 8% but symptomatic benefit
was in 15% of Pt. As a function of waiting time to receive E in second line it was a
higher response rate in Ps who received E without waiting time, toxicity of E was
represented by rash grade I 80%, diarrhea 10%, dizziness 3%, ocular dysfunctions
2%. Grade III of toxicity was observed only in 3% of patients. Toxicity for senior
adults treated by E. was similar with younger Pt.
Conclusions: Despite the limits of a retrospective study we can conclude that E is
useful in second and third line treatment for advanced lung cancer, chemotherapy
could have benefit in third line after E, and senior adults have about the some
response and benefit from E. Toxicity was reduced for all Pt treated with E.
Disclosure: All authors have declared no conflicts of interest.
1223 HYPERBARIC OXYGENATION AND EP (CISPLATIN AND
ETOPOSIDE) CHEMOTHERAPY IN TREATMENT OF PATIENTS
WITH ADVANCED NON SMALL CELLS LUNG CANCER
(NSCLC)
M.V. Kopp 1 , I.A. Koroleva 1 , S.V. Kozlov 2 , L.V. Shaplygin 3 , M.E. Popova 1 ,
J.G. Kutyreva 1
1 Chemotherapy, Samara Regional Clinical Oncology Dispensary, Samara,
RUSSIAN FEDERATION, 2 Oncological, Samara State Medical University,
Samara, RUSSIAN FEDERATION, 3 Samara Oncology Center, Samara, RUSSIAN
FEDERATION
Background: By the time of diagnosis more than 75% of all lung cancer patients
have locally advanced or metastatic process. According to WHO, at different stages
of treatment to 80% of lung cancer patients need chemotherapy. Malignant neoplasm
lead to the development of tissue oxygen deficiency or directly related to acute or
chronic hypoxia. Hypoxia of normal tissue is one of the reasons of chronic anemia
in patients with advanced NSCLC. We conducted an analysis of toxicity of
chemotherapy in patients with advanced NSCLC by means of chemotherapy
concurrently with hyperbaric oxygenation.
Materials and methods: Between October 2010 and March 2012 63 patients with
advanced NSCLC were treated with EP chemotherapy regimen (Cisplatin 75mg/m2
on day 1 + Etoposide 120mg/m2 in 1, 3, 5 days). Cycles repeated every 21 days. We
used two hyperbaric pressure chamber: BLKS 303MK and BLKS-307 Khrunichev.
Hyperbaric oxygenation procedures are held under pressure 1.3 atm for 40 minutes,
1 time a day every day for 5 consecutive days. All the patients were divided into 2
groups. 28 patients received chemotherapy only. 35 patients received chemotherapy
ix398 | Abstracts Volume 23 | Supplement 9 | September 2012